Evaluation of Pain Management in Patients Undergoing LVAD Therapy via Thoracotomy and Median Sternotomy Approach

Purpose Left ventricular assist devices (LVADs) have become a critical component of heart failure therapy. Many efforts are made to reduce complications and hospital length of stay. Thoracotomy and median sternotomy are both used as surgical approaches. Here, we investigated pain level and opioid use in the peri-operative stage in patients undergoing LVAD implantation via thoracotomy or median sternotomy approach. Methods : We retrospectively reviewed 55 patients who underwent left ventricular assist device (LVAD) implantation between 2017-2020. Of these, 41 (75%) LVADs were implanted via median sternotomy approach and 14 (25%) LVADs were implanted via thoracotomy. Maximum pain score at day 3 and 7 post-op, at discharge and first follow-up visit were evaluated for both groups. In addition, amount of oxycodone given in the peri-operative period in both groups was investigated. Results Both groups were similar in age and gender distribution ( Table 1 ). Heartmate III® was the main VAD type implanted in the sternotomy group (76%; n=31) while HVAD Heartware® was in the thoracotomy group (86%; n=12). There was no difference in the mean length of ICU stay or hospital stay between the groups (both p>0.05; Table 1 ). While there was a decrease in median pain score from day 3 post-op to first visit follow-up in both groups, the pain score was comparable between the two groups at day 3 and 7 post-op, at discharge and first-follow-up ( Table 1 ). Also, we did not find a significant difference in oxycodone use between thoracotomy and median sternotomy groups. Conclusion Both thoracotomy and median sternotomy approach resulted in similar peri-operative pain level and opioid use in patients undergoing LVAD implantation.